Differential Diagnosis for Lower Abdominal Pain
Single Most Likely Diagnosis
- Diverticulitis: Given the lower abdominal pain and elevated white blood cell count (WBC) with a high absolute neutrophil count, diverticulitis is a strong consideration. The absence of bowel obstruction features and the presence of mild colonic fecal retention do not rule out this diagnosis, as diverticulitis can present with a range of abdominal findings.
Other Likely Diagnoses
- Appendicitis: Although the X-ray does not show specific signs of appendicitis, the elevated WBC and lower abdominal pain could still suggest this diagnosis, especially if the appendix is not visualized or is in an atypical location.
- Gastroenteritis: The elevated WBC could indicate an infectious process. Gastroenteritis, while often presenting with diarrhea and vomiting, could be considered, especially if the patient has a history of recent travel, food poisoning, or exposure to someone with similar symptoms.
- Inflammatory Bowel Disease (IBD) Flare: Conditions like Crohn's disease or ulcerative colitis can present with abdominal pain and elevated inflammatory markers. The absence of specific radiographic findings does not rule out an IBD flare.
Do Not Miss Diagnoses
- Ectopic Pregnancy: In women of childbearing age, ectopic pregnancy is a critical diagnosis to consider with lower abdominal pain, even with a normal abdominal X-ray. The elevated WBC could be seen in ectopic pregnancy due to associated infection or inflammation.
- Ovarian Torsion: This is another gynecological emergency that can present with severe lower abdominal pain. The lack of specific findings on X-ray does not exclude this diagnosis.
- Intestinal Ischemia: Although less common, intestinal ischemia can present with abdominal pain and elevated WBC. It is crucial to consider this diagnosis, especially in older patients or those with risk factors for vascular disease.
Rare Diagnoses
- Yersinia or Other Atypical Infections: Certain bacterial infections, such as Yersinia, can cause mesenteric adenitis, which might present with lower abdominal pain and elevated WBC.
- Neoplastic Processes: Although less likely given the acute presentation, certain neoplasms (e.g., lymphoma) could cause abdominal pain and elevated inflammatory markers.
- Intra-abdominal Hemorrhage: This could be due to various causes, including trauma, vascular anomalies, or anticoagulation. The absence of organomegaly or specific radiographic findings does not entirely rule out this possibility, especially if the patient has risk factors.